2007年临床常见病原菌分布及耐药性分析

目的分析2007年临床常见病原菌的分布及其对常用抗生素的耐药情况，以指导临床合理用药。方法利用Vitek．32及ATB自动微生物分析仪对病原菌进行鉴定和药物敏感试验，同时对葡萄球菌、肠球菌、肺炎链球菌、大肠埃希菌、肺炎克雷伯菌和奇异变形杆菌分别进行MRS、HLAR、PRSP和ESBLs的检测。结果2007年共分离到8239株病原菌，其中革兰阴性菌4836株，占58．7％；革兰阳性菌2364株，占28．7％；真菌1038株，占12．6％。大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌是临床最常见的革兰阴性杆菌。大肠埃希菌和肺炎克雷伯菌产ESBLs株检出率分别为51．0％和32．5％，肠杆菌科细菌对碳青霉烯类、丁胺卡那、哌拉西林／他唑巴坦、头孢哌酮／舒巴坦耐药率较低，耐药率在1．1％～39．9％。铜绿假单胞菌对亚胺培南的耐药率为22．0％。葡萄球菌中，MRSA和MRCNS的检出率分别为49．2％和81．6％，未分离到耐万古霉素葡萄球菌。HLAR肠球菌和VRE的检出率分别为63．5％和5．3％，PRSP的检出率为14．6％。真菌对氟康唑耐药率较高，对其余4种抗真菌药物较敏感。结论临床常见病原菌仍以革兰阴性杆菌为主，病原菌的耐药性明显升高，因此应加强医院感染病原菌分布及耐药性监测，合理使用抗生素，减少耐药菌株的流行，降低医院感染的发生率。

Distribution of Pathogens and Antimicrobial resistance analysis in 2007

Objective To investigate distribution of Pathogens and Antimicrobial resistance and guide drug treatment in clinic. Methods the identification and Antimicrobial susceptibility test of pathogens were detected by Vitek-32 and ATB microbiologic analyzer. MRS, HLAR, PRSP and ESBLs were detected in Staphylococcus, enterococcus, Streptococcus pneumonia and gram-negative bacilli, respectively. Results Among 8239 strains isolated in 2007, Gram-negative bacteria, Gram-positive bacteria and fungi were 58.7%, 28.7%, 12.6%, respectively. Escherichia coli, Pseudomonas aeruginosa and Klebsiella pneumoniae were the most predominant strains in gram-negative bacilli. The ESBLs producing Escherichia coli and Klebsiella pneumoniae were 51.0% and 32.5%, respectively. Isolates of Enterobacteriaceae were still Highly sensitive to imipenem, meropenem, Amikacin, Piperacillin-tazobactam, Cefoperazone-sulbactam, which The resistance rates were from 1.1% to 39.9%. The rates of imipenem resistance of Pseudomonas aeruginosa were 22.0%. Methicillin resistant strains in S.anreus （MRSA） and coagulase negative Staphylococcus （MRCNS） accounted for 49.2% and 81.6%, and No vancomycin resistant strains were detected.63.5% and 53.% of enterococci were HLAR and VRE strains. PRSP accounted for 14.6% among all the isolated S pneumonia. Fungus were highly resistant to Fluconazole while sensitive to the other four antifungal agents. Conclusions Gram-negative bacilli were the most predominant strains in clinic. Bacterial resistance increased significantly in recent years. The surveillance of bacterial resistance and reasonably using antibiotic could reduce production and dissemination of drug resistant strains.